Thank you for your question. What I can describe is what I do in my surgical practice but I cannot speak for the other surgeons who may have differing practices and hence the downtime and results may also be different. In my practice of facial fat grafting, I prefer to use much less fat to get similar if not better results as I do not believe in overfilling a face. The entire procedure is usually performed under deep sedation so that I can minimize the amount of anesthetic injections, which can cause unnecessary facial swelling and bruising. My patients are put on a special post-operative regime to reduce swelling and promote recovery.
Even with these precautions there is still significant swelling and downtime of about 1 week or more. Younger patients who tend to require less fat grafts or patients who have smaller grafted areas tend to recover faster. Nonetheless, the swelling in the first week is significant and you will not be able to meet people professionally or socially. Most of the swelling would have resolved after the first week. It would be ideal to straddle your recovery between two weekends to give a maximum of 9 days before returning to work. Most bruises will also have settled by then. However, you will probably still find your face slightly swollen and the best results are only seen at the 3rd week.
This is a brief rundown of how the fat grafting is done:
Pre-operative assessment. An in-person consultation and clinical examination with an experienced doctor is important to establish your treatment goals and expectations. A 3D assessment with a simulator will be useful to give you an ideal of how you can look like after surgery.
Fat graft harvest. The fat graft can be harvested from several possible donor sites such as; the tummy, inner thighs, arms. The fat is harvested using specialised Tulip cannulas that ensure that the parcels of fat that are harvested are small and ideal for fat grafting. Special cannulas are also used so as to increase the survival rate for the fat
Processing of microfat for structural fat grafting. The fat grafts for the face are processed differently from fat grafts to other parts of the body such as breast or buttocks. I routinely process them using the Coleman technique so as to ensure the highest graft take whilst minimising the incidence of lumps. The fat is centrifuged. Afterwhich, the excess blood is drained and the oil is wicked away. The purified fat graft is then transferred into 1cc syringes in preparation for fat grafting to the face. Nanofat, if required for facial rejuvenation can also be prepared by using specialized Tulip filters.
Fat injection. The prepared fat is carefully injected into the targeted areas. Common areas for structural fat grafting in the face include:
1. Forehead
2. Temples
3. Tear trough
4. Sunken upper eyelid
5. Midcheek
6. Nasolabial folds
7. Marionette lines
8. Chin
9. Earlobes
What to expect? In comparison to other procedures, the pain from fat grafting and from the donor sites are minimal and should be manageable with painkillers. Most of the pain would resolve in a day or two. Immediately after surgery, there will be swelling and bruises to the injected areas as well as the donor sites for fat harvest. The swelling should subside in a week or two and the bruises may take a week to disappear.
I hope this answers your questions. Have a great week ahead!
Dr. Terence Goh
